Indian Rupee Travel Card Application Form  
  Please fill in the form in BLOCK LETTERS  
Our simple application form takes around 10 minutes to be completed. Once you complete this application form, click on "Review and Print" at the end of the page. If you are happy with the information on "Review" page, please click on "Print" to print the completed application form.
In order to process your application, we will need the below documents sent to us by post to "Indian Rupee Travel Card, ICICI Bank UK PLC, PO Box 68921, One Thomas More Square, London E1W 9HB"
1. Self attested copies of your identity and address proofs - When sending copies of your documents by post, each document should be self attested (signed) with the words "This is a true copy of the original" and have your signature.
Valid proof of address (Any one) Criteria
1) Utility bills - Electricity bill, Landline telephone bill, Gas bill , Water bill (Any one) The date of issue of any of these utility bills must be within the last 3 months.
2) Valid UK driving license Handwritten/ Provisional/ Temporary/ Learning driving license is not acceptable. Also any handwritten/ unauthorised alteration on driving license is not acceptable.
3) Bank or Building society statement For all bank statements/ passbooks, there should be at least two customer-induced transactions in the last 3 months prior to the time of submitting an address proof. Typical customer induced transactions include ATM withdrawals, debit card transactions and cheques cleared.
4) Council Tax bill Current year's council tax bill
Valid proof of identity Criteria
1) A copy of the front and back pages of your Passport Valid for at least six months
2. A recent passport sized photograph of you.
3. Completed and signed application form (a signature on page 2 and two signatures on page 3).
  Residential ADDRESs  
  contact details  
  TEXT Alerts  
  (A subscription charge of 250 Indian Rupees (INR) plus applicable service tax applies for this service).  
  passport DETAILS  
  India Travel Details  
  Purpose of Travel  
  Linked Account Details  
(Your UK current Account from which you will transfer the funds to load your Card)
(Six digit Sort code number of your UK Current A/c to help us identify the Bank and branch where the account is held)
     I authorise ICICI Bank, its group companies and representatives to provide me information on various products, offers and services provided by them through telephone, emails and text messages.
   I authorise ICICI Bank to use, share and exchange my personal or business information including processed information with group
companies and selected third parties for marketing and to provide information about available products and services through telephone, email and text

If you later decide that you would prefer not to receive any information regarding the products, offers and services, you may inform us either by email or
by phone.
  Please note that the card issuance fee of INR 350 plus applicable service tax will be deducted from the first amount loaded on the Card by you.  
  Capitalised words and expressions used but not defined will have the same meaning as those in the Terms and Conditions.

I confirm and agree that:
  1. I have read, understood and accept the ICICI Bank Indian Rupee Travel Card Terms and Conditions. These are the standard terms and conditions on which ICICI Bank Limited will provide this product and related services. I understand that any changes to the Terms and Conditions will be made available by giving me notice either by post, email, text or through the Website at least one month in advance.
  2. ICICI Bank Limited will close the Card on the 180th day from the date of Card activation.
  3. ICICI Bank UK PLC acts as a distributor and only assists in facilitating my documentation to initiate the relationship with ICICI Bank Limited India, who is issuing and managing the Indian Rupee Travel Card.
  4. All the information provided in this application form (and all documents provided with this form) is correct, complete, up to date and I have not withheld any information. I agree to provide any further information that ICICI Bank Limited or ICICI Bank UK PLC may require relating to using the Card.
  5. ICICI Bank Limited may reject this application. I agree and understand that ICICI Bank Limited or ICICI Bank UK PLC may retain the application form and any copy of the documents provided by me.
  6. Issuance and the distribution of the Card is not regulated by the Financial Conduct Authority of United Kingdom (UK). This product is not covered under the UK regulatory and compensation regimes such as Financial Services Compensation Scheme (FSCS).
  7. The issuance of this product is regulated by the Reserve Bank of India and governed by Indian law.
  8. I authorise ICICI Bank to exchange, share or disclose the information provided herein including personal information with institutions, agencies, credit bureaus and any regulatory or statutory bodies to comply with its legal obligations.
  Please ensure that prior to submitting the application form you have read and understood the:  
  Signature of the customer  
  FORM A2 - Form to be filled for refund of remaining balance on Card  
  Application and Declaration (To be completed by the applicant)  
  Application for drawal of foreign exchange  
I. Details of the applicant-
II. Details of the foreign exchange required
  1.     Amount (Specify currency)   : Unused balance on Indian Rupee Travel Card
2.     Purpose : Conversion of Indian Rupees to Great British Pound
  III.    I authorise you to debit my Saving Bank/Current/RFC/EEFC Account No./ICICI Bank Indian Rupee Travel Card number ________________
together with your charges and
  * a)     Effect the foreign exchange remittance directly to -  
  1.     Applicant/ Beneficiary's Name* :  
  2.     Linked Account No.*:  
  3.     Sort Code*:  
  4.     Bank/ Building Society Name & Address* :  
  * b)     Issue a draft : Beneficiary's Name :                       NA                   
            Address :                                                            NA                   
  * c)     Issue travellers cheques for :                                 NA                   
  * d)     Issue foreign currency notes for :                           NA                   
            (Strike out whichever is not applicable)  

(Under FEMA 1999)
  I, declare that -

*     1) The total amount of foreign exchange purchased from or remitted through, all sources in India during this calendar year including this application is
           the unused balance on Indian Rupee Travel Card the annual limit prescribed by Reserve Bank of India for the said purpose.
*     2) Foreign exchange purchased from you is for the purpose indicated above.
          (Strike out whichever is not applicable)
Before sending the application form; please tick the checklist below to ensure you are sending all the required documents to process your application.
Application form along with completed Form A2
Passport sized photograph
Copy of ID Proof
Copy of Address Proof
Both ID and address proof should be self attested (signed) with the words "This is a true copy of the original."
  Review and Print  
  For Office use only  
  I have verified the following documents with the originals.  
  Passport Copy  
  Address Proof  
Reference: IRTC001
AD Code No. :          S0306         

Form No.      : ________________
Currency :           GBP          

Amount    : Unused balance
                 on Indian Rupee Travel Card
AD Code No. :Unused balance
                     on Indian Rupee Travel Card

(To be filled in by Authorised Dealer)
  Review and Print